| NPI | 1063532687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37PC00461400) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00193100) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2024-02-20 |